The development of vaccine therapies has saved many lives over the decades. Measles, mumps, and rubella (MMR) are highly contagious viral infections that can produce serious effects or complications. Delivery of MMR vaccines has become standard practice for individuals in the United States and in other parts of the developed world.
It is important for healthcare professionals, including pharmacists, to be aware of these infections. They must be aware of the sign and symptoms, associated complications, and vaccine requirements for children and other vulnerable populations that can prevent these diseases.
The introduction of the vaccines against measles, mumps, and rubella in the United States have reduced the rates of outbreaks in the United States. However, those who have decided to not vaccinate can place others at risk of contracting the disease. Pharmacists are in an important position to educate the public about these infections.
Related: A Review of Measles, Mumps, and Rubella for Pharmacists and Pharmacy Technicians
The origins of measles, mumps, and rubella
A clear understanding of the origins of MMR can prove to be critical to infection prevention. The measles, or rubeola virus, is a ribonucleic acid (RNA) virus that is a part of the Paramyxoviridae family within the Morbillivirus genus. Transmission is airborne or via contact with secretions of an infected individual.
According to the World Health Organization, given the high rate of contamination and fatality associated with contraction, vaccination can mean the difference between life and death for those who are not immune or unvaccinated.
Similar to measles, mumps is also an RNA virus that falls under the Paramyxoviridae family within the Rubulavirus genus. Mumps can occur during any season of the year but are more prevalent in the winter and spring. The rates of mumps in the United States have declined since the late 1960s. However, outbreaks can still occur. Recent outbreaks happened in the Midwest in 2006 and in 2009-2010 in the East Coast and Canada.
Lastly, rubella or German measles is another RNA virus that falls in the Togaviridae family within the Rubivirus genus. While mumps and rubella are human diseases with no animal reservoirs, this is not the case for measles. With measles, humans are the only host.
The ability to recognize the distinguishing features of measles, mumps, and rubella is the first step to providing patients with the immediate care they need.
Symptoms and complications of measles
The presentation of MMR can be distinctive among each of the three infections. With measles, the symptoms start to appear about 10-12 days after exposure. The characteristic hallmark of symptoms can occur during the prodromal stage of the infection. It includes a fever lasting for 2-3 days, malaise, cough, conjunctivitis, and coryza.
As the infection moves towards the end of the prodromal stage, the signature maculopapular erythematous rash can appear on the face and expand to other areas of the body. The notable complications include pneumonia and diarrhea. More severe complications can occur with unvaccinated young children and pregnant individuals. In pregnant women, measles can cause fetal complications or the potential for spontaneous abortion.
Symptoms and complications of mumps
The prodromal phase of mumps presents at around 14 to 18 days after exposure. Symptoms include headaches, fever, anorexia, or myalgia. Around 50% of people who are infected can present with nonspecific symptoms. Roughly 20% do not have any symptoms. The rest are at risk of developing partitas.
Significant complications can include deafness or aseptic meningitis. The risk of spontaneous abortion can also occur with pregnant women around the first trimester.
Symptoms and complications of rubella
For rubella, the symptoms that present can be fairly mild in nature and transient. During the prodromal stage of the infection, patients can present with a low grade fever, feelings of malaise, or lymphadenopathy. Similar to measles, a mild maculopapular rash may develop on the face and move down the body at around 14 to 17 days after exposure.
While the symptoms of rubella can be mild, the transmission to the fetus during pregnancy can lead to serious effects. These can range from premature delivery to cardiac issues or death.
The MMR vaccine
Experts consider the MMR vaccine to be safe and effective against measles, mumps, and rubella. Vaccination offers immunity for individuals that receive two of the recommended doses. The applicable vaccines are MMR-II and PRIORIX. These can be used interchangeably to defend the body from infection.
The Center for Disease Control and Prevention recommends that healthcare providers administer the MMR vaccine (0.5ml) subcutaneously or intramuscularly (in certain cases) at 12 to 15 months of age. The second dose should be administered at 4 to 6 years of age. If 28 days have passed between the first and second doses, providers can administer the second dose of the vaccine prior to the age of 4.
Adults who do not have an established immunity should receive at least one dose of MMR vaccine. Those who have a high risk of transmission should receive two doses separated by 28 days.
However, special populations should not receive the MMR vaccine. These include:
- People with severe, life-threatening allergies
- Those who are currently pregnant or may become pregnant
- Patients with a weak immune system
- Tuberculosis patients
- Those who have received a recent blood transfusion or other blood products
Before a provider administers the MMR vaccine, the immunizing pharmacist must carefully assess if the patient meets the criteria for it or have existing contraindications.
Conclusion
Given the highly contagious nature of measles, mumps, and rubella, it’s critical for pharmacists to provide patients with vaccine education. The knowledge of the presenting symptoms and complications of MMR can allow the pharmacist to educate and advise, when appropriate, when it comes to the next course of action for protection against the complications of these infections.
